A losing battle?

Monday

Jul 1, 2013 at 12:01 AM

As health officials work to reduce the more than 20 million painkillers prescribed in Jackson County each year, patients who have become addicted to opiates — including heroin — and want to find help often must wait weeks or months for treatment.

By MANDY VALENCIA

As health officials work to reduce the more than 20 million painkillers prescribed in Jackson County each year, patients who have become addicted to opiates — including heroin — and want to find help often must wait weeks or months for treatment.

Patients who need residential treatment can wait from three to eight weeks for a bed to become available in a publicly funded facility, says Rita Sullivan, executive director of OnTrack Inc. addiction recovery programs and services in Medford.

"It's really tough to put someone on a waiting list who is asking for help," Sullivan says.

Addictions Recovery Center in Medford offers 28 beds, 14 funded by public money and 14 available on a sliding scale or for insured individuals, according to Christine Mason, ARC executive director.

Statewide, there are 40 providers of drug treatment programs, six of those publicly funded, offering 500 beds for adults, according to Karen Wheeler, administrator for the Addictions and Mental Health Division of the Oregon Health Authority.

"There are definitely some needs in terms of increased capacity for treatment for opiate addiction," Wheeler says.

Those who want — and can afford — private residential treatment programs now must travel to Eugene or Salem after Asante closed its Genesis Recovery Center in 2009. Operating costs had outpaced revenue as the number of patients declined, in part because of poor coverage offered in insurance policies and co-payments that ran to thousands of dollars, officials said at the time.

More money for Jackson County's publicly funded treatment programs and more involvement from the medical community are needed to curb addiction to opioids and heroin locally, Sullivan says.

Many addicts progress to heroin when they can no longer get or afford prescription painkillers.

"We can improve the outcomes if we integrate, like health care transformation is guiding us to do, if we have a medical presence," says Sullivan.

She envisions doctors on staff at treatment facilities who help counselors manage patients' withdrawal symptoms and ongoing treatment regimens.

"It's a hard class of drugs to treat," Sullivan says. "It has to be treated on multiple levels. There are great programs, but we need help with the medical elements."

State Sen. Alan Bates says he is working to increase the amount of funding given to mental health and drug treatment programs by as much as 18.4 percent as this year's legislative session winds down, but as of press time lawmakers had yet to approve a budget.

"That's more money put into the system, which is a substantial amount," says Bates. "It's part of a package to get people off drugs and save lives. It's the right thing to do."

Having the ability to treat patients quickly with drug addictions is imperative, Bates says.

"You have opportunity with patients. You have to strike when the iron's hot. You have to have programs set up where you have capacity," he says.

"The care team would develop a plan with an intent to taper off the opiate dose with alternative or adjunctive therapy," says Kuhl.

Doctors at the hospital also are encouraged to use the prescription drug monitoring program, a secure database that tracks controlled substances, to ensure patients aren't shopping doctors and pharmacies for more opiates.

"Doctors can look and track who and how much is being prescribed," Kuhl says. "It's optional, but we look at this website when we have concerns, or randomly to make sure there is no prescribing habits from multiple prescribers."

There are two ways opiate addiction is treated — through sobriety-based programs and medication, says Dr. Jim Shames, medical director for Jackson County Health and Human Services.

Sobriety-based treatment includes counseling, Narcotics Anonymous meetings and/or residential programs in which patients stay on-site while they go through withdrawal.

Medication-assisted treatment includes counseling and group meetings plus medications, such as methadone or Suboxone, which help reduce withdrawal symptoms.

"Here's the deal. Opioid withdrawal is terrible," Shames says. "People hate it. It makes you feel like you're going to die. You're not, but it makes you feel like you're going to die."

Withdrawal from opiates is different than from cocaine, methamphetamine, benzodiazepine (a type of sedative) or alcohol, Shames says.

"It's just different, and for people going through it, their reaction is often quite different. The truth of the matter is, relapse is very high," he says.

Not all physicians and treatment specialists agree that medication-assisted treatment is the answer for opiate addiction. Some view it as trading one drug for another.

Bates, who has been working closely with Shames to combat the growing opiate addiction problem statewide, says for the most part he opposes using medications in treatment for opiate addiction.

"I think on a temporary basis they have value, but I think people need to get into treatment and get off of them," says Bates.

The local methadone clinic treats about 600 patients who are addicted to heroin and other opiates, Shames says. Statewide, about 5,000 people are in methadone programs, according to Wheeler.

Methadone is a synthetic narcotic that's been used for 50 to 60 years, Shames says. It helps addicts kick their addiction by "occupying" the brain receptor sites affected by narcotics, according to the Centers for Disease Control and Prevention. It relieves the craving for opiates and blocks their euphoric effects, and it does not cause intoxication, allowing methadone users to lead normal lives. Because it is classified as a controlled substance, it is carefully regulated.

Suboxone provides the same relief for addicts but has been approved federally for dispensing in an office setting.

Suboxone is "a lot safer, and some physicians can prescribe it from their office," Shames says. "Aside from being more expensive, in many ways it's probably a cleaner, safer drug to use if you have the option."

But Shames acknowledges the expense of the medication can be a barrier for those who are trying to get help.

"The price is coming down for Suboxone, but it's still pretty expensive," he says. "It could easily cost $200, $300, $400 a month for treatment."

A federal grant called Access to Treatment Recovery is available that provides funding for those who can't afford treatment. Recipients must be older than 18, live in Jackson County and have a chemical dependency diagnosis. To apply, residents must complete a face-to-face eligibility screening/assessment at Jackson County Human Services, 1000 E. Main St. Medford. (Call 541-774-7800 to make an appointment.)

Care Coordinator Shane Semin meets with potential recipients of the grant to determine eligibility. For more information on the grant, see www.oregon.gov and search for "ATR."

For "Sara," a 35-year-old Ashland resident who asked not to be identified, receiving the grant was the only way she could get medication-assisted treatment and get clean.

Sara became addicted when her then-boyfriend, whom she says was a heroin dealer in Ashland, convinced her to smoke it with him.

"Opium was how it was presented to me. I smoked one hit and all my worries went away," she says. "I was in a bad place. He said it was from poppies grown in the Applegate by hippies and that it was completely natural. After four days I needed it to function."

When she finally reached out for help, it took several tries before she was successful at shaking her addiction, she says.

"I was on the floor just convulsing," she says, describing withdrawal symptoms. "I was just begging my man to kill me. It's like you're having a constant panic attack."

She took Suboxone for nine months and now has two years of sobriety under her belt, she says. She says she still meets with counselors at Kolpia, a private, outpatient treatment and counseling center with offices in Medford and Ashland.

Even now, though, she doesn't feel the same.

"When you're done, you've created this mess for yourself and you don't deal with things the same. That's been tricky for me ... learning myself again," says Sara. "I hope one day I can be back. I feel like a part of my soul died. I don't regret or hate myself or feel shame. Because I've watched 98 percent of everyone else be unsuccessful with it."

According to Michelle Moore, a clinical supervisor at Kolpia, recovering addicts need time to implement new coping skills as they learn to live without opiates.

"Sometimes I feel sad about the situation," says Ernie Flores, another clinical supervisor at Kolpia. "But at least they are here for help. What if they weren't? There's hope in the progress people make. It's very rewarding."

Counselors at Kolpia say after two heroin overdose deaths in Ashland in December 2012 and another in January, several new patients came to the clinic for help. In response to this they started an opiate addicts group that meets every Monday at 3 p.m.

"The deaths were unfortunate, but it inspired some to get help," Moore says.